COVID-19 ripped the bandage off racial and ethnic disparities in health care that emergency nurses have faced their entire careers.
There are clear, understandable and correctable reasons behind the realization that every community of color in the United States has been disproportionately affected by the pandemic compared to the white population.
“To move into the future, we have to acknowledge the past,” said Cheryl Randolph, an emergency nurse at San Francisco General Hospital. “Unconscious bias, white privilege and structural inequalities create differentiated health care service offerings and deliveries that affect the effectiveness and outcomes of care.”
Randolph, a member of the ENA Board of Directors, discussed the origins of health disparities and ways to address them yesterday during Color-Me Unbiased: Resolving Racial Inequality in Healthcare.
Health inequalities and disparities are nothing new, she explained, but COVID-19 vividly highlighted the deadly effects of established biases. Among white Americans, COVID-19 accounted for about 33 age-adjusted deaths per 100,000 as of August 2020. The toll was 44 deaths per 100,000 among Asian Americans, 99 among Latinos, 105 among Pacific Islanders, 111 among Indigenous peoples and 118 among Blacks.
The age-adjusted death rate accounts for differences in age distribution among populations.
“There is a pandemic of health disparities in our society,” Randolph said. “Health disparities are driven by social and economic disparities in employment, education, housing, food security, community, health coverage, access to health care and more. To fix our health disparities, we must fix our structural inequities. Three in 10 white children live in poverty, [while half of all] Black children live in poverty. That has to change.”
The first step in addressing inequities is to understand them. The United States has been a multiracial, multicultural society since its founding, she noted, but white privilege has dominated. Look no further than the ubiquitous adhesive bandage. It has been available in “flesh tones” for decades, but until recent years, the only tone was a light beige.
The new standard in health care is diversity, equity and inclusivity.
Diversity means that every group has a seat at the table. Equity means that every group gets what they need to succeed. Inclusivity means that everyone has a seat at the table and, more importantly, that everyone has a voice — and is heard.
The second step in addressing health care inequities is to measure, document and include them in electronic health records to help identify at-risk populations — and not just clinical factors, Randolph said, noting that 80 percent of factors affecting health status are non-clinical. That includes behaviors, such as tobacco use, diet and exercise; social and economic factors, such as education, employment and income; and environmental factors, including pollution, housing and transportation.
The final, and hardest, step is taking action.
“One person can make a tremendous difference,” Randolph said. “Work with local communities. Schools and churches are great ways to access local communities. Meet with local elected officials. Be present, be personal and be involved.”
In a live audience-engagement session following Randolph’s presentation, Emergency Nursing 2021 attendees shared their own experiences combatting inequity through DEI training for staff and food distribution.
Jason Carter, a nurse manager at Norman Regional Health System in Oklahoma, said his hospital hands out bags with enough food for three or four days to homeless individuals.
“Our job has this huge social aspect, and sometimes that’s the overwhelming need that brought them into the ED instead of a physical ailment,” Randolph acknowledged. “Unfortunately, for better or for worse, we have to tend to all of these needs of our people.”
She underscored the need for effective DEI education for emergency nurses, highlighting ENA resources including other sessions on the topic at Emergency Nursing 2021.
Session recordings will be available for on-demand viewing on the virtual meeting platform through Jan. 31.